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Abstract

Peripheral artery disease (PAD) affects more than 200 million individuals worldwide, and those with exertional leg discomfort, rest pain, and tissue or limb loss have significantly impaired functional status and quality of life. Despite their lower associated risk of repeat revascularization, open surgical procedures have been largely supplanted by endovascular intervention for symptomatic PAD given the lower associated morbidity and mortality. Although standalone plain-old percutaneous transluminal angioplasty (PTA) was previously the standard endovascular strategy for these patients, high procedural failure and restenosis rates led to the development of new therapeutic technologies. Stent implantation improved procedural success, and a recent meta-analysis of randomized trials suggests that bare metal stenting (BMS) results in half as much restenosis as PTA. Nevertheless, restenosis following femoropopliteal BMS occurs in up to 37% of patients within 12 months and observational data suggest that by 5 years, primary patency rates are roughly equivalent (41%±4% for BMS vs. 36%±3% for PTA, p=0.31).